Transcript How to Prevent Harmful Events and Promote Patient Safety

Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Chapter 5
Culture and Gender Issues in Patient-Safe
Communication
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Beliefs
North American Values
Personal control over environment
Change
Time and it’s control
Equality
Individualism/privacy
Self-help
Competition
Future orientation
Action/work orientation
Informality
Directness/openness/honesty
Practicality/efficiency
Materialism/acquisitiveness
vs
Other Cultures
Fate
Tradition
Human interaction
Hierarchy/rank/status
Group’s welfare
Need help
Cooperation
Past orientation
“Being” orientation
Formality
Indirectness/subtlety
Idealism
Spirituality
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Assessment
 Heritage: What is the patient’s country of
origin? Is the patient familiar with the healthcare system and health-care providers in this
country?
 Communication: Are there language barriers?
Will the patient feel comfortable sharing
thoughts and feelings?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Assessment
 Family roles and organization: Who is the
dominant member of the household, the person
in the family who is the spokesperson and
decision maker?
 Biocultural ecology: What are the specific genetic
or environmentally transmitted diseases that
cause health problems in the different cultural
groups?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Assessment
 High-risk behaviors: Does the cultural group use
tobacco, alcohol, or recreational drugs? Is
participation in high-risk physical activities
common? Is there a lack of adherence to
important health safety practices?
 Nutrition: What are the basic ingredients of
native food dishes and preparation practices?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Assessment
 Pregnancy and childbearing practices: What are the
preferences for birth control methods, the roles of
men in childbirth, the positions for delivering a baby,
and the preferred types of health practitioners (male
or female, midwife or obstetrician)?
 Death rituals: What is the patient’s view of death,
dying, and an afterlife?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cultural Assessment
 Spirituality: What is the patient’s dominant
religion and views regarding the meaning and
purpose of life?
 Health-seeking beliefs and behaviors: What
are the patient’s beliefs about pain, mental
and physical handicaps, chronic illness, and
folklore practices?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Gender Differences in Styles of Speech
 Purpose of recognizing gender differences in styles of
communication:
1. Understand ourselves and
members of the opposite gender
2. Apply the knowledge to
facilitate communication with
members of the opposite gender
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Gender Differences in
Styles of Communication
Women focus communication on intimacy and forming communal
connections.
Goal: Establish and negotiate intimate, sympathetic, and harmonious
relationships.
Men focus communication on hierarchy and attaining and
demonstrating status in a group.
Goal: To be independent, to demonstrate importance, and to attain
high status. Compete to be the best in the group.
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Most women use a “rapport” style of
communication for everyday conversation
 Communicate to establish connection, display
similarities, and match experiences
 Female friendships: Talk about how they think
and feel
 Call each other to “chat” and make “small talk”
 Pay attention to intimate and personal details,
what happened, who was there….
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women’s Rapport Talk
 Most comfortable with private
conversations due to the intimate and
personal exchanges
 As a result, women are very good at
expressing themselves: thoughts & feelings
 Women are much better at expressing
themselves than many men
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Rapport Talk vs Gossip
 “Gossiping women”….negative connotation
 Gossip is destructive: Rumors, slander, and
defamation of character; does not create
rapport
 The purpose of rapport talk is to establish and
facilitate relationships
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Most men use a “report” style of
communication for everyday conversation
 To assert independence and to
maintain or augment status in social
group
 Freely announce and state facts to give
an account
 “Skip-the-details”
 Straightforward and direct
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men and Report Talk
 Like to tell others what to do: increases
independence and status
 Taking orders lowers status and decreases
independence
 Like to talk about their knowledge and skill
 Like to tell success stories about their
accomplishments
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men and Report Talk
 Like to hold center state through a verbal
performance
 Like to impart information, appear
knowledgeable, and give advice
 More comfortable talking in groups made up
of people they don’t know well
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Who Talks More…..
Men talk more than women…..Women spend
more time listening
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
How Have We Learned to Manage Conflict?
 Boys’ games: Complex rules, specific
roles, relied-upon skills
 Girls’ games: Focused on verbally
managing interpersonal relationships,
popularity contests
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Conflict and Women
 Threat to connection and should be avoided
 Strive for peace and harmony in conversation
 Prefer to settle disputes without direct
confrontation
 Some women avoid conflict at all costs; unable
to express anger
 Sacrifice personal needs for the needs of the
group
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women at Work
 Place higher value on affiliation and collective
goals than personal achievement
 When making decisions, tend to take into
account more factors, with a higher sensitivity
to personal and moral aspects of problems
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men and Conflict
 Comfortable with conflict and competition
 Friendships involve competition and friendly
aggression
 Thrive on team sports, golfing, fishing, and
“who’s the best”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men at Work
 Recognize some people are on top and some
are on the bottom when it comes to status
 Everyone has a function to perform and
everyone is not equal
 More interested in being respected than in
being liked
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Cooperative Overlapping vs Talking Alone
Communication overlapping:

Listener talks along with speaker

Speaker not annoyed by the intrusion

Purpose of overlapping is to show
support, interest, cooperation, and
emotional ties
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Overlapping vs Interruption
 Interruption: Violation of speaking rights;
inconsiderate
 Individual’s intended overlap may be perceived as
interruption by another
 Cultural pattern: Italians, Asians, and Filipinos talk
together
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
 Many women overlap more than men: Build
relationships
 Many men may consider overlap an
interruption: Want center stage to
demonstrate independence and status
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Who interrupts more?
 Women say their messages are often
interrupted with “Get to the point!”
 Men often consider efforts to show support by
interruption
 Research indicates men interrupt women
more
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Seek a balanced conversation
 If one speaker overlaps and the other gives
way, the conversation is not balanced
 If the person overlaps, you can overlap also
 If the person does not overlap, let him/her
speak
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
If you feel you are being interrupted:
“Please let me finish want I was saying.”
“I’m not done yet; let me finish.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
If you are in the habit of interrupting:
Take a deep breath, hold it a second, and
really listen to what the other person is
trying to say as you exhale
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Listener vs Information Provider
 Women listen more
Active listening; play down expertise to
promote harmony
 Men seek opportunities to give information
Value center stage while speaking; gives them
feeling of knowing more, having importance &
status
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Aim for balanced listening and providing
information
Men speaking together

Challenge the content of the message

Match information with their own
expertise

Sidetrack the speaker to a different
topic
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
If you do not challenge or match
information…
 Person knows nothing about the topic
 May feel obliged to keep on lecturing
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women view…
 Sidetracks as rude, not listening
 Listening to a lecture as boring
Both men and women mutually dissatisfied
with women listening and men providing
information
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men vs Women in Listening
Women:
 Nod head in encouragement
 Say “yes” as encouragement
Men:
 Focus on the message and literal meanings
 Nod only if they agree
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men & Women
Listening vs Talking
 Women tend to ask more questions,
encouraging further verbal expressions
 Women attempt to draw quieter members
of a group into conversation
 Men assume that anyone who has
something to say will volunteer it
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Are You Listening?
 Many men avoid eye contact because it makes
them uncomfortable
 If a speaker expects verbal and nonverbal
feedback, it is very frustrating not to have eye
contact
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
If the purpose of speech is to express
intimacy…
The speaker will become frustrated with a
listener making statements or issuing
challenges rather than asking questions
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Some people do not like to listen at
length…
 Listening makes them feel subordinate
 The act of giving information is dominant and
is given higher status than listening
Interesting: a person who is an unwilling
listener will listen quietly to a lecture from a
supervisor with higher status
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Listening/speaking is out of balance…
If you find yourself talking a lot, and the other
person is doing all the listening…..
Stop talking; ask a question to draw the other
person into the conversation
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
If the other person is doing all the
talking….
 Challenge
 Match information
 Sidetrack
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Storytelling
All people, regardless of gender, like
to tell stories
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men and Storytelling
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Human contests
Act alone
Are successful
Rarely receive advice
Hunting, fishing, golf, etc.
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women and Storytelling
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Personal experiences
Revolve around relationships
Peculiar people
Dramatize abnormal behavior
Violation of social norms
Who did what to whom under what
circumstances
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Gender Differences in
Language Usage
Tag Questions: Adding a phase at the
end of a sentence to turn it into a
question
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women: Tag Questions
Woman works hard all day and says:
Woman: “I’d like to go out to eat, wouldn’t
you?”
Man: “I’d rather stay in tonight.”
Woman’s interpretation: “He doesn’t care about me
because he doesn’t want to go out even when he
knows I do.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Purpose of Tag Question
 Hear another’s thoughts
 Encourage the expression of opinions
 Men prone to respond more literally to a
question
 Men give opinions and honest answers
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Tag questions: What do you think? Why?
Purpose:
 Make others feel involved
 Ask opinions before a decision is made
 Decisions based on consensus
Misinterpretation:
 Make the decision for me
 Speaker lacks confidence to make a decision
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Net effect of tag questions:
Speaker appears less intelligent
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
To Communicate Clearly
 Do not ask tag questions; make statements.
 Do not give a person a choice if there really
isn’t one.
 Pose questions carefully and clearly: “I need
your insight into this problem.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women’s conversational rituals — phrases to
promote harmonious relationships
“I’m sorry”— to show empathy, not meaning the
speaker did something wrong
Man wonders — What is she sorry for?
“ Thanks” — often tacked on the end of a
conversation, when there is nothing to be
thankful about
Man wonders — Why is she thanking me?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women’s Rituals: Compliments
 Women offer more compliments
 Give more compliments to other women than
to men
 People like praise, but it becomes annoying if
habitual
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men and Conversational Rituals
 Joke
 Sarcasm
 Tease
 Playful putdowns
Joking and teasing is a way of getting attention associated with
attaining status
Women tell fewer jokes and usually do not find teasing, sarcasm,
and putdowns funny; instead, damaging to relationships
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Gender and Nonverbal Communication:
Body Language
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Women’s Body Language
Women:
 Take up less space
 Invade personal space less often
 Gesture more fluidly
 Lower their eyes in a negative encounter (look insecure)
 Open eyes wide to make a point (look naïve)
 Smile and nod their heads more
 Sit closer and look directly at each other while speaking
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Men’s Body Language
Men:
 Sit further apart
 Sit at angles
 Do not look at each other when speaking
 Touch women more often than vice versa
 To women, may appear not to be paying
attention.